https://doi.org/10.55788/0b6a2bf2
Prurigo nodularis is what Prof. Gil Yosipovitch (University of Miami, FL, USA) called “one of the most challenging conditions that dermatologists deal with.” Dupilumab might now present a solution for this difficult-to-treat condition. Following the positive results in a prurigo nodularis phase 2 trial, a second phase 2 trial, LIBERTY-PN PRIME (NCT04183335), was performed to assess the efficacy and safety of dupilumab in prurigo nodularis [1]. The primary study endpoint was the proportion of patients with a ≥4-point improvement (reduction) in their worst itch numerical rating scale (WI-NRS) from baseline to week 24. A clear (0) or almost clear (1–5 prurigo nodularis lesions) outcome in the investigator´s global assessment (IGA) at week 24 was a secondary endpoint.
All enrolled participants suffered from severe itch, a high lesion count, and an impaired quality-of-life. Their prurigo nodularis was inadequately controlled by topical therapy and over two thirds had previously used systemic therapy. “Almost all participants were treated before but a lot of them were treated with antihistamines, which is not helpful,” Prof. Yosipovitch commented. The study treatment was completed by 59 participants in the placebo group and 74 in the dupilumab group.
At week 24, a statistically significantly higher percentage of participants in the dupilumab group achieved the primary endpoint (60.0% vs 18.4%; P<0.0001; see Figure). Moreover, a significantly higher percentage of participants treated with dupilumab achieved clear or almost clear skin according to the IGA (48.0% vs 18.4%; P=0.0004). “This is a really robust change, considering that these lesions take time to heal,” Prof. Yosipovitch commented.
Figure: Proportion of patients with ≥4-point improvement in WI-NRS at week 24 and proportion of patients achieving IGA PN-S 0 or 1 at week 24 [1]
WI-NRS, worst itch numeric rating scale; IGA PN-S 0 or 1, Investigator´s global assessment prurigo nodularis 0 or 1 (equalling clear or almost clear prurigo nodularis lesions).
There was no difference regarding the side effects between dupilumab and placebo. “Clearly, we need treatment for prurigo nodularis and this treatment has shown that it leads to a clinical relevant improvement,” Prof. Yosipovitch concluded.
- Yosipovitch G, et al. Dupilumab significantly improves itch and skin lesions in patients with prurigo nodularis: results from a 2nd phase 3 trial (LIBERTY-PN PRIME). EADV Congress 2022, Milan, Italy, 7–10 September.
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Table of Contents: EADV 2022
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Letter from the Editor
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Fern extract reverses severe actinic keratosis lesions
Vitiligo in 2022
Enhancing re-pigmentation rates with topical ruxolitinib in all body areas
Markedly lower skin cancer risk in vitiligo patients
Pruritus Treatment: Novel Agents Entering the Arena
Dupilumab leads to clinically relevant improvements in signs and symptoms of prurigo nodularis
Nalbuphine: aspiring to become another treatment for prurigo nodularis?
Notalgia paresthetica: may κ-opioid receptor agonists be a long-awaited effective therapy?
Pharmacotherapy in Hidradenitis Suppurativa: New Opportunities
High potential for secukinumab as next biologic treatment for HS
Hidradenitis suppurativa: TYK2/JAK1 inhibitor shows promise
Best of the Posters
High rate of non- or partial responders jeopardises therapeutic success in HS
Genital psoriasis: high prevalence, often underdiagnosed
Decreased overall survival in melanoma patients with low vitamin D
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IL-13 inhibition with lebrikizumab shows high maintenance rates in AD
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Roflumilast foam led to high response rates in seborrheic dermatitis
What Is Hot in Hair Disorders?
Long-term improvement in alopecia areata with ritlecitinib therapy
Topical gel plus finasteride beneficial for patients with androgenetic alopecia
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